Provider Demographics
NPI:1275898769
Name:WAGES, JENNIFER JEAN (ATC, OTC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JEAN
Last Name:WAGES
Suffix:
Gender:F
Credentials:ATC, OTC
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:JEAN
Other - Last Name:GUY SUTHERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, OTC
Mailing Address - Street 1:6011 E WOODMEN RD
Mailing Address - Street 2:STE 120
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2602
Mailing Address - Country:US
Mailing Address - Phone:719-574-8383
Mailing Address - Fax:719-574-8548
Practice Address - Street 1:3010 N CIRCLE DR
Practice Address - Street 2:STE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1182
Practice Address - Country:US
Practice Address - Phone:719-632-7669
Practice Address - Fax:719-632-0088
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT-9952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer